Meditation during the Preoperative Period

April 17, 2020

Surgery can be a stressful time for patients and their families. The perioperative period can elicit feelings of fear and anxiety1 as well as physical stress, such as cardiovascular and hemodynamic instability2 or symptoms associated with medications.3 Distress is not only a side effect of surgery, but may also lead to various complications such as pain, increased risk of infection, nausea and vomiting, delayed wound healing and lengthy hospital stays.4 Anesthetic agents may contribute to a patient’s psychological and physical stress, leading to long-term conditions including chronic pain, posttraumatic stress disorder (PTSD) and learning difficulties.5 Because perioperative anesthesia can cause stress, anesthesia providers are responsible for making the patient’s experience as relaxing as possible.6 Strategies to reduce perioperative stress may include guided imagery, exercise, biofeedback, hypnosis, massage and music therapy.7 Recent studies have focused on combining some of these strategies into meditation routines for patients.8,9 Due to their role in reducing a patient’s anxiety and pain, anesthesia providers should be familiar with the practice of meditation and its use in the perioperative period. 

Meditation can take a variety of forms.10 In popular culture, there are six general types: mindfulness meditation, in which one observes thoughts without judging them or becoming involved in them; spiritual meditation, which entails reflection and connection with a higher being or the universe; focused meditation, which involves concentration using any of the five senses; movement meditation, which includes gentle motion to find peace in action; mantra meditation, which uses a repetitive sound or chant to clear the mind; and transcendental meditation, which is a silent, structured form of meditation.10 Meditation is also available to many populations, and has been used to address many different needs and conditions. For example, Woods-Giscombé and Gaylord studied the cultural relevance of mindfulness meditation for African Americans, who experience a disproportionate rate of stress-related health conditions due to discrimination and societal inequities.11 Krisanaprakornkit et al. reviewed the efficacy of meditation therapy in anxiety disorders, though they wrote their paper in 2006 and thus had few studies to analyze.12 In their pilot study, Lavretsky et al. found that brief daily yogic meditation by family dementia caregivers led to improved mental and cognitive functioning and lower levels of depressive symptoms, as well as increased telomerase activity (i.e., better cell longevity).13 Meanwhile, Wachholtz and Pargament compared secular and spiritual forms of meditation, finding that participants engaging in spiritual meditation showed greater decreases in anxiety and more positive mood, spiritual health, spiritual experiences and pain tolerance than those using a secular meditation or relaxation technique.14 Overall, meditation has many forms and can be applied to many contexts. 

One area where meditation has become more popular is the perioperative period. Given its stress-relieving effects and the importance of anxiolysis for proper recovery, meditation may be useful in improving patients’ health outcomes. For one, meditation can help reduce patients’ anxiety before a procedure. According to a study by Felix et al., preoperative guided imagery relaxation therapy—considered a meditative practice—effectively reduced state anxiety and blood cortisol levels in patients undergoing video-laparoscopic bariatric surgery.15 Kiran et al. found that Rajyoga meditation, a type of mind-body intervention, was effective in reducing anxiety and cortisol levels in patients undergoing elective coronary artery bypass surgery.16 According to Erian and Erian, training patients in mindfulness meditation before surgery has many benefits, including low cost, low time commitment, hastened recovery, minimized analgesic consumption and improved overall satisfaction.8 Indeed, Yi et al. found that preoperative mindfulness-based stress reduction (MBSR) therapy was associated with lower back pain 30 days after lumbar spine surgery.9 However, this was a pilot study, and the authors emphasize that more research is needed to assess the efficacy of preoperative MBSR on postoperative outcomes.9 Meditation techniques may even be useful during and after a procedure to improve outcomes. Kurdi and Gasti found that intraoperative meditation music improved Cesarean section patients’ postoperative experiences by reducing postoperative pain and anxiety and improving psychological well-being.17 Though more research is needed to establish the best types, times and contexts of meditation interventions, evidence shows they have the potential to improve patients’ perioperative experiences. 

Surgery and anesthesia can be stressful on the mind and body. Stress can cause long-term health issues and impair proper recovery from surgery. While medications may be used to alleviate stress and combat difficult bodily changes, clinicians can also provide their patients with non-medication interventions, such as meditation. Meditation is useful for stress relief in a variety of contexts, including before, during and after a procedure. Future research should investigate the long-term health effects of different perioperative meditation therapies. Additionally, more studies are needed to evaluate the importance of dispositional or personality-based mindfulness in perioperative outcomes.18 

1.Kain ZN. Perioperative Psychological Trauma. In: Atlee JL, ed. Complications in Anesthesia (Second Edition). Philadelphia: W.B. Saunders; 2007:682–684. 

2.Manecke GR, Maus TM. Cardiovascular Monitoring in Noncardiac Surgery. In: Kaplan JA, Cronin B, Maus TM, eds. Essentials of Cardiac Anesthesia for Noncardiac Surgery. New York: Elsevier; 2019:198–213. 

3.Duke J. Alcohol and Substance Abuse. In: Duke J, ed. Anesthesia Secrets (Fourth Edition). Philadelphia: Mosby; 2011:336–342. 

4.Gul C, Gursoy A. The effect of preoperative distress on the perioperative period. Journal of Anesthesia and Intensive Care Medicine. 2017;2(3):555–588. 

5.Borsook D, George E, Kussman B, Becerra L. Anesthesia and perioperative stress: Consequences on neural networks and postoperative behaviors. Progress in Neurobiology. 2010;92(4):601–612. 

6.Mohan B, Kumar R, Attri JP, Chatrath V, Bala N. Anesthesiologist’s Role in Relieving Patient’s Anxiety. Anesthesia, Essays and Researches. 2017;11(2):449–452. 

7.Selimen D, Andsoy II. The Importance of a Holistic Approach During the Perioperative Period. AORN Journal. 2011;93(4):482–490. 

8.Erian C, Erian M. Meditate to Medicate: Mindfulness Meditation as a Complementary Therapy for Surgical Patients. Australian Medical Student Journal. 2017. 

9.Yi JL, Porucznik CA, Gren LH, et al. The Impact of Preoperative Mindfulness-Based Stress Reduction on Postoperative Patient-Reported Pain, Disability, Quality of Life, and Prescription Opioid Use in Lumbar Spine Degenerative Disease: A Pilot Study. World Neurosurgery. 2019;121:e786–e791. 

10.Bertone HJ, Young J. Which Type of Meditation Is Right for Me? Healthline. Web: Healthline Media; June 9, 2017. 

11.Woods-Giscombé CL, Gaylord SA. The Cultural Relevance of Mindfulness Meditation as a Health Intervention for African Americans: Implications for Reducing Stress-Related Health Disparities. Journal of Holistic Nursing. 2014;32(3):147–160. 

12.Krisanaprakornkit T, Sriraj W, Piyavhatkul N, Laopaiboon M. Meditation therapy for anxiety disorders. Cochrane Database of Systematic Reviews. 2006(1). 

13.Lavretsky H, Epel ES, Siddarth P, et al. A pilot study of yogic meditation for family dementia caregivers with depressive symptoms: Effects on mental health, cognition, and telomerase activity. International Journal of Geriatric Psychiatry. 2013;28(1):57–65. 

14.Wachholtz AB, Pargament KI. Is Spirituality a Critical Ingredient of Meditation? Comparing the Effects of Spiritual Meditation, Secular Meditation, and Relaxation on Spiritual, Psychological, Cardiac, and Pain Outcomes. Journal of Behavioral Medicine. 2005;28(4):369–384. 

15.Felix MMDS, Ferreira MBG, Oliveira LFd, Barichello E, Pires PdS, Barbosa MH. Guided imagery relaxation therapy on preoperative anxiety: A randomized clinical trial. Revista Latino-Americana de Enfermagem. 2018;26:e3101. 

16.Kiran U, Ladha S, Makhija N, et al. The role of Rajyoga meditation for modulation of anxiety and serum cortisol in patients undergoing coronary artery bypass surgery: A prospective randomized control study. Annals of Cardiac Anaesthesia. 2017;20(2):158–162. 

17.Kurdi MS, Gasti V. Intraoperative Meditation Music as an Adjunct to Subarachnoid Block for the Improvement of Postoperative Outcomes Following Cesarean Section: A Randomized Placebo-controlled Comparative Study. Anesthesia, Essays and Researches. 2018;12(3):618–624. 

18.Weston E, Raker C, Huang D, Parker A, Robison K, Mathews C. The Association Between Mindfulness and Postoperative Pain: A Prospective Cohort Study of Gynecologic Oncology Patients Undergoing Minimally Invasive Hysterectomy. Journal of Minimally Invasive Gynecology. 2019.